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Using a Very Low Energy Diet to Achieve Substantial Preconception Weight Loss in Women with Obesity: A Review of the Safety and Efficacy. Nutrients 2022; 14:nu14204423. [PMID: 36297107 PMCID: PMC9608905 DOI: 10.3390/nu14204423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity in women of reproductive age is common. Emerging evidence suggests that maternal obesity not only increases the risk of adverse pregnancy outcomes but also has an enduring impact on the metabolic health of the offspring. Given this, management of obesity prior to pregnancy is critically important. Almost all international guidelines suggest that women with obesity should aim to achieve weight loss prior to pregnancy. However, current pre-conception weight loss therapies are sub-optimal. Lifestyle modification typically results in modest weight loss. This may assist fertility but does not alter pregnancy outcomes. Bariatric surgery results in substantial weight loss, which improves pregnancy outcomes for the mother but may be harmful to the offspring. Alternative approaches to the management of obesity in women planning pregnancy are needed. Very low energy diets (VLEDs) have been proposed as a possible tool to assist women with obesity achieve weight loss prior to conception. While VLEDs can induce substantial and rapid weight loss, there are concerns about the impact of rapid weight loss on maternal nutrition prior to pregnancy and about inadvertent exposure of the early fetus to ketosis. The purpose of this review is to examine the existing literature regarding the safety and efficacy of a preconception VLED program as a tool to achieve substantial weight loss in women with obesity.
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Abstract
Importance The pandemic of obesity during pregnancy now afflicts 1 out of every 2 pregnant women in the United States. Even though unintended pregnancy has decreased to 45% of all pregnancies, 50% of those unintended pregnancies occur in obese women. Objective This study aims to identify why current lifestyle interventions for obese pregnancy are not effective and what the newer complications are for obesity during pregnancy. Evidence Acquisition Available literatures on current treatments for maternal obesity were reviewed for effectiveness. Emerging maternal and infant complications from obesity during pregnancy were examined for significance. Results Limitations in successful interventions fell into 3 basic categories to include the following: (1) preconception weight loss; (2) bariatric surgery before pregnancy; and (3) prevention of excessive gestational weight gain during pregnancy. Emerging significant physiological changes from maternal obesity is composed of inflammation (placenta and human milk), metabolism (hormones, microbiome, fatty acids), and offspring outcomes (body composition, congenital malformations, chronic kidney disease, asthma, neurodevelopment, and behavior). Conclusions and Relevance Are current prepregnancy lifestyle and behavioral interventions feasible to prevent maternal obesity complications? Epigenetic and metabolomic research will be critical to determine what is needed to blunt the effects of maternal obesity and to discover successful treatment.
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Matusiak K, Barrett HL, Lust K, Callaway LK, Dekker Nitert M. Self-reported periconception weight loss attempts do not alter infant body composition. Nutrition 2020; 77:110781. [PMID: 32283340 DOI: 10.1016/j.nut.2020.110781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 02/10/2020] [Accepted: 02/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Maternal obesity increases the risk for adverse infant outcomes; therefore, achieving an optimal body mass index before conception is recommended. Periconceptional maternal weight loss, however, has been associated with adverse outcomes for the fetus, including altered body composition in animal studies. It is not clear whether periconception weight loss alters infant body composition in humans. The aim of this study was to compare body composition in offspring of women who attempted to lose or maintain weight in the periconception period. METHODS Women who delivered a healthy term infant were grouped according to attempt to lose weight. Infant body composition was determined by air displacement plethysmography and anthropometric measurements. RESULTS In a cohort of 73 women, 27 attempted to lose weight and 46 maintained weight in the periconception period. Infant birth weight, percent body fat, and head and arm circumference were not altered by maternal attempts to lose weight. Infant abdominal circumference was increased in the offspring of women who attempted to lose weight in the periconception period. Infant percent body fat was increased in overweight and obese mothers and in female infants. CONCLUSION The results of this study showed that attempts to lose weight in the periconception period do not significantly alter infant body composition. The increase in abdominal circumference may indicate a difference in fat distribution in offspring of women who attempted to lose weight, which may increase their risk for future metabolic and cardiovascular disease.
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Affiliation(s)
- Kristine Matusiak
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Helen L Barrett
- Faculty of Medicine, The University of Queensland, Herston, Australia; Mater Medical Research Institute, South Brisbane, Australia
| | - Karin Lust
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Leonie K Callaway
- Faculty of Medicine, The University of Queensland, Herston, Australia; Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Australia.
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Bennett WL, Coughlin JW. Applying a Life Course Lens: Targeting Gestational Weight Gain to Prevent Future Obesity. J Womens Health (Larchmt) 2020; 29:133-134. [PMID: 31895648 DOI: 10.1089/jwh.2019.8254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Price SA, Sumithran P, Nankervis A, Permezel M, Proietto J. Preconception management of women with obesity: A systematic review. Obes Rev 2019; 20:510-526. [PMID: 30549166 DOI: 10.1111/obr.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
The prevalence of women of child-bearing age with obesity continues to rise at an alarming rate. This has significant implications for both the short-term and long-term health of mother and offspring. Given the paucity of evidence-based literature in this field, the preconception management of women with obesity is highly variable both between institutions and around the world. This systematic review aims to evaluate studies that inform us about the role of preconception weight loss in the fertility and pregnancy outcomes of women with obesity. Current therapeutic interventions are discussed, with a specific focus on the suitability of weight loss interventions for women with obesity planning pregnancy. There are significant knowledge gaps in the current literature; these are discussed and areas for future research are explored.
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Affiliation(s)
- Sarah A Price
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
| | | | - Michael Permezel
- Department of Obstetrics and Gynaecology (Mercy Hospital for Women), University of Melbourne, Heidelberg, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
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Lang AY, Harrison CL, Boyle JA. Preconception Lifestyle and Weight-Related Behaviors by Maternal Body Mass Index: A Cross-Sectional Study of Pregnant Women. Nutrients 2019; 11:nu11040759. [PMID: 30935152 PMCID: PMC6521092 DOI: 10.3390/nu11040759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 01/24/2023] Open
Abstract
Obesity is a rising global health challenge, particularly for reproductive-aged women. Our cross-sectional study of pregnant women (n = 223) examined associations between preconception body mass index (BMI) and socio-demographics, weight perceptions and lifestyle behaviors. Over half of women were overweight (33.2%) or obese (22.0%), 49.6% of which perceived their weight as normal. High proportions of women reported planning their pregnancies (70.0%) and were actively trying to lose or maintain their weight preconception (72.7%). Weight management approaches varied from reducing discretionary foods (63.7%) to professional support (8.1%). Obese women had significantly greater odds of reducing discretionary foods (odds ratio (OR) = 6.69 95% confidence interval (CI) 2.13–21.00, p = 0.001) and using structured diets (adjusted odds ratio (AOR) = 9.13 95% CI 2.90–28.81, p < 0.001) compared to normal-weight women. After adjusting for socio-demographics, compared to normal-weight women, overweight (AOR = 5.24 95% CI 2.19–12.56, p < 0.001) and obese (AOR = 2.85 95% CI 1.06–7.67, p = 0.04) women had significantly increased odds of exercising for weight management and significantly lower odds of taking folic-acid preconception (overweight: AOR = 0.40 95% CI 0.18–0.90, p = 0.01, obese: AOR = 0.38 95% CI 0.16–0.91, p = 0.03). Large proportions of women planning a pregnancy have an overweight/obese BMI, with associated suboptimal health behaviors and reduced health professional engagement preconception. Further research exploring women’s perspectives regarding preconception lifestyles is needed to inform effective preconception health promotion strategies.
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Affiliation(s)
- Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
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Callaway LK, McIntyre HD, Barrett HL, Foxcroft K, Tremellen A, Lingwood BE, Tobin JM, Wilkinson S, Kothari A, Morrison M, O'Rourke P, Pelecanos A, Dekker Nitert M. Probiotics for the Prevention of Gestational Diabetes Mellitus in Overweight and Obese Women: Findings From the SPRING Double-Blind Randomized Controlled Trial. Diabetes Care 2019; 42:364-371. [PMID: 30659070 DOI: 10.2337/dc18-2248] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Given the role of gut microbiota in regulating metabolism, probiotics administered during pregnancy might prevent gestational diabetes mellitus (GDM). This question has not previously been studied in high-risk overweight and obese pregnant women. We aimed to determine whether probiotics (Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis) administered from the second trimester in overweight and obese women prevent GDM as assessed by an oral glucose tolerance test (OGTT) at 28 weeks' gestation. Secondary outcomes included maternal and neonatal complications, maternal blood pressure and BMI, and infant body composition. RESEARCH DESIGN AND METHODS This was a double-blind randomized controlled trial of probiotic versus placebo in overweight and obese pregnant women in Brisbane, Australia. RESULTS The study was completed in 411 women. GDM occurred in 12.3% (25 of 204) in the placebo arm and 18.4% (38 of 207) in the probiotics arm (P = 0.10). At OGTT, mean fasting glucose was higher in women randomized to probiotics (79.3 mg/dL) compared with placebo (77.5 mg/dL) (P = 0.049). One- and two-hour glucose measures were similar. Preeclampsia occurred in 9.2% of women randomized to probiotics compared with 4.9% in the placebo arm (P = 0.09). Excessive weight gain occurred in 32.5% of women in the probiotics arm (55 of 169) compared with 46% in the placebo arm (81 of 176) (P = 0.01). Rates of small for gestational age (<10th percentile) were 2.4% in the probiotics arm (5 of 205) and 6.5% in the placebo arm (13 of 199) (P = 0.042). There were no differences in other secondary outcomes. CONCLUSIONS The probiotics used in this study did not prevent GDM in overweight and obese pregnant women.
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Affiliation(s)
- Leonie K Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia .,Faculty of Medicine, The University of Queensland, Herston, Australia
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, Herston, Australia.,Mater Medical Research Institute, South Brisbane, Australia
| | - Helen L Barrett
- Faculty of Medicine, The University of Queensland, Herston, Australia.,Mater Medical Research Institute, South Brisbane, Australia
| | - Katie Foxcroft
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Anne Tremellen
- Mater Medical Research Institute, South Brisbane, Australia
| | | | | | - Shelley Wilkinson
- Mater Medical Research Institute, South Brisbane, Australia.,Department of Nutrition and Dietetics, Mater Group, South Brisbane, Australia
| | | | - Mark Morrison
- Faculty of Medicine, University of Queensland Diamantina Institute, Translational Research Institute, Woolloongabba, Australia
| | - Peter O'Rourke
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Australia
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Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study. Midwifery 2018; 63:1-7. [DOI: 10.1016/j.midw.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 01/20/2023]
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9
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Dodd JM, Briley AL. Managing obesity in pregnancy – An obstetric and midwifery perspective. Midwifery 2017; 49:7-12. [DOI: 10.1016/j.midw.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/03/2017] [Indexed: 11/15/2022]
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van der Pligt P, Bick D, Furber C. Tackling maternal obesity: Building an evidence base to reflect the complexity of lifestyle behaviour change. Midwifery 2017; 49:1-3. [PMID: 28215699 DOI: 10.1016/j.midw.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paige van der Pligt
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Australia.
| | - Debra Bick
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery/Women's Health Division, London, UK
| | - Christine Furber
- Faculty of Biology, Medicine and Health, University of Manchester, UK
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11
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Harden SM, Ramalingam NS, Wilson KE, Evans-Hoeker E. Informing the development and uptake of a weight management intervention for preconception: a mixed-methods investigation of patient and provider perceptions. BMC OBESITY 2017; 4:8. [PMID: 28191322 PMCID: PMC5295190 DOI: 10.1186/s40608-017-0144-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
Background It is recommended for women to have a healthy body mass index before conception. However, there is limited research on appropriate preconception interventions for weight loss. Furthermore, there is a lack of knowledge on providers’ willingness to refer to particular behavioral interventions and the degree to which patients would attend those interventions. Methods A cross-section of 67 patients and 21 providers completed surveys related to their demographics and willingness to refer/attend a number of interventions for weight loss. A case study of three patients from the target audience was used to elicit detailed feedback on preconception weight status and weight loss intervention. Results Overall, patients were willing to attend a variety of interventions, regardless of BMI category. Focus group participants shared that weight loss prior to conception would be beneficial for them and their child, but cited barriers such as time, location, and the way providers encourage weight loss. Providers were willing to refer to a number of behavioral interventions, and were less willing to prescribe weight loss medications than other intervention options. Conclusions A number of intervention strategies may be well received by both patients and providers in preconception care to assist with weight loss prior to conception. Future research is needed on intervention effects and sustainability. Electronic supplementary material The online version of this article (doi:10.1186/s40608-017-0144-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA.,Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
| | - NithyaPriya S Ramalingam
- Virginia Tech Translational Biology, Medicine, and Health Program, 1981 Kraft Dr, Blacksburg, VA USA
| | - Kathryn E Wilson
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA
| | - Emily Evans-Hoeker
- Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
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12
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Hampton KD, Newton JM, Parker R, Mazza D. A qualitative study of the barriers and enablers to fertility-awareness education in general practice. J Adv Nurs 2016; 72:1541-51. [DOI: 10.1111/jan.12931] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Kerry D. Hampton
- Department of General Practice; Monash University; Melbourne Victoria Australia
| | - Jennifer M. Newton
- School of Nursing and Midwifery; Monash University; Clayton Victoria Australia
| | - Rhian Parker
- Centre for Research and Action in Public Health; University of Canberra; Australian Capital Territory Australia
| | - Danielle Mazza
- Department of General Practice; Monash University; Melbourne Victoria Australia
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13
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Weight-related risk perception among healthy and overweight pregnant women: a cross-sectional study. J Perinatol 2015; 35:683-8. [PMID: 26043418 DOI: 10.1038/jp.2015.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate weight-related risk perception in early pregnancy and to compare this perception between women commencing pregnancy healthy weight and overweight. STUDY DESIGN Pregnant women (n=664) aged 29±5 (mean±s.d.) years were recruited from a metropolitan teaching hospital in Australia. A self-administered questionnaire was completed at around 16 weeks of gestation. Height measured at baseline and self-reported pre-pregnancy weight were used to calculate body mass index. Cross-sectional analysis was conducted.Differences between groups were assessed using chi-squared tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables depending on distribution. RESULT Excess gestational weight gain (GWG) during pregnancy was more important in leading to health problems for women or their child compared with pre-pregnancy weight. Personal risk perception for complications was low for all women, although overweight women had slightly higher scores than healthy-weight women (2.4±1.0 vs 2.9±1.0; P<0.001). All women perceived their risk for complications to be below that of an average pregnant woman. CONCLUSION Women should be informed of the risk associated with their pre-pregnancy weight (in the case of maternal overweight) and excess GWG. If efforts to raise risk awareness are to result in preventative action, this information needs to be accompanied by advice and appropriate support on how to reduce risk.
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Charaf S, Wardle JL, Sibbritt DW, Lal S, Callaway LK. Women's use of herbal and alternative medicines for preconception care. Aust N Z J Obstet Gynaecol 2015; 55:222-6. [DOI: 10.1111/ajo.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/10/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Safa Charaf
- School of Medical and Molecular Biosciences; University of Technology Sydney; Ultimo New South Wales Australia
| | - Jonathan L. Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM); Faculty of Health; University of Technology Sydney; Ultimo New South Wales Australia
| | - David W. Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM); Faculty of Health; University of Technology Sydney; Ultimo New South Wales Australia
| | - Sara Lal
- School of Medical and Molecular Biosciences; University of Technology Sydney; Ultimo New South Wales Australia
| | - Leonie K. Callaway
- School of Medicine; University of Queensland; Herston Queensland Australia
- UQ Centre for Clinical Research; University of Queensland; Herston Queensland Australia
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15
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Funk KL, LeBlanc ES, Vesco KK, Stevens VJ. Women's attitudes towards a pre-conception healthy lifestyle programme. Clin Obes 2015; 5:67-71. [PMID: 25735259 DOI: 10.1111/cob.12088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/11/2014] [Accepted: 01/11/2015] [Indexed: 12/14/2022]
Abstract
Nearly half of US women begin pregnancy overweight or obese and more than half of overweight or obese pregnant women experience excessive gestational weight gain. Recent lifestyle intervention programmes have helped women avoid excessive weight gain during pregnancy, but helping women lose weight before pregnancy may be a more effective way to improve pregnancy outcomes. This study assessed women's attitudes towards pre-conception diet and weight management interventions. An anonymous survey was conducted in patients waiting in a health maintenance organization's obstetrics and primary care waiting rooms. It focused on attitudes towards participating in a pre-conception, lifestyle change programme. Eighty percent of the 126 women surveyed were pregnant or considering pregnancy within 5 years. Of the 126 respondents, 60 (48%) were overweight or obese. Of these, 96% rated healthy diet and healthy weight before pregnancy as very important or important and 77% favoured a healthy lifestyle programme (diet, weight management and physical activity) before becoming pregnant. Likewise, overweight or obese women reported being likely or highly likely to participate in specific intervention programme aspects such as keeping phone appointments (77%), using a programme website (70%) and keeping food and exercise records (63%). Survey results show that women in this population believe that adopting a healthy lifestyle and losing weight are important before pregnancy and that they are enthusiastic about programmes that will help them achieve those goals in preparation for pregnancy.
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Affiliation(s)
- K L Funk
- Center for Health Research, Kaiser Permanente, Portland, OR, USA
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16
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Miller M, Hearn L, van der Pligt P, Wilcox J, Campbell KJ. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care. Aust J Prim Health 2014; 20:123-7. [PMID: 24176286 DOI: 10.1071/py13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/02/2013] [Indexed: 01/15/2023]
Abstract
Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
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Affiliation(s)
- Margaret Miller
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Lydia Hearn
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Jane Wilcox
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
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Increased maternal BMI is associated with infant wheezing in early life: a prospective cohort study. J Dev Orig Health Dis 2014; 5:351-60. [PMID: 25081820 DOI: 10.1017/s2040174414000312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Rates of obesity are increasing in women of child bearing age with negative impacts on maternal and offspring health. Emerging evidence suggests in utero origins of respiratory health in offspring of obese mothers but mechanisms are unknown. Changes in maternal cortisol levels are one potential factor as cortisol levels are altered in obesity and cortisol is separately implicated in development of offspring wheeze. We aimed to assess whether increased pre-pregnancy maternal body mass index (BMI) was associated with offspring early life wheezing, and whether this was mediated by altered cortisol levels in the mother. In a prospective community-based cohort (Amsterdam Born Children and their Development cohort), women completed questionnaires during pregnancy and at 3-5 months post-delivery regarding self-history of asthma and atopy, and of wheezing of their offspring (n=4860). Pre-pregnancy BMI was recorded and serum total cortisol levels were measured in a subset of women (n=2227) at their first antenatal visit. A total of 20.2% (n=984) women were overweight or obese and 10.3% reported wheezing in their offspring. Maternal BMI was associated with offspring wheezing (1 unit (kg/m2) increase, OR: 1.03; 95% CI: 1.00-1.05), after correction for confounders. Although maternal cortisol levels were lower in overweight mothers and those with a history of asthma, maternal cortisol levels did not mediate the increased offspring wheezing. Pre-pregnancy BMI impacts on baby wheezing, which is not mediated by lower cortisol levels. As the prevalence of obesity in women of child-bearing age is increasing, further studies are needed to investigate modifiable maternal factors to avoid risk of wheezing in young children.
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18
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Sui Z, Turnbull D, Dodd J. Effect of body image on gestational weight gain in overweight and obese women. Women Birth 2013; 26:267-72. [DOI: 10.1016/j.wombi.2013.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 05/02/2013] [Accepted: 07/06/2013] [Indexed: 11/24/2022]
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Edvardsson K, Lindkvist M, Eurenius E, Mogren I, Small R, Ivarsson A. A population-based study of overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations. BMC Public Health 2013; 13:923. [PMID: 24090153 PMCID: PMC3854510 DOI: 10.1186/1471-2458-13-923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/27/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Overweight and obesity in pregnancy increase the risk of several adverse pregnancy outcomes. However, both mothers' and fathers' health play an important role for long-term health outcomes in offspring. While aspects of health and lifestyle of pregnant women have been reported, the health of expectant fathers and correlations of health variables within couples have received less attention. This study aimed to explore the prevalence and socio-demographic patterns of overweight and obesity in Swedish expectant parents, and to assess within-couple associations. METHODS This population-based, cross-sectional study investigated self-reported data from 4352 pregnant women and 3949 expectant fathers, comprising 3356 identified couples. Data were collected in antenatal care clinics between January 2008 and December 2011. Descriptive, correlation and logistic regression analyses were performed. RESULTS The self-reported prevalence of overweight (BMI 25.0-29.99) and obesity (BMI ≥ 30.0) was 29% among women (pre-pregnancy) and 53% among expectant fathers. In a majority of couples (62%), at least one partner was overweight or obese. The odds of being overweight or obese increased relative to partner's overweight or obesity, and women's odds of being obese were more than six times higher if their partners were also obese in comparison with women whose partners were of normal weight (OR 6.2, CI 4.2-9.3). A socio-demographic gradient was found in both genders in relation to education, occupation and area of residence, with higher odds of being obese further down the social ladder. The cumulative influence of these factors showed a substantial increase in the odds of obesity for the least compared to the most privileged (OR 6.5, CI 3.6-11.8). CONCLUSIONS The prevalence of overweight and obesity in expectant parents was high, with a clear social gradient, and a minority of couples reported both partners with a healthy weight at the onset of pregnancy. Partner influence on health and health behaviours, and the role both mothers and fathers play in health outcomes of their offspring, underpin the need for a more holistic and gender inclusive approach to the delivery of pregnancy care and postnatal and child health services, with active measures employed to involve fathers.
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Affiliation(s)
- Kristina Edvardsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87 Umeå, Sweden.
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Cardozo ER, Dune TJ, Neff LM, Brocks ME, Ekpo GE, Barnes RB, Marsh EE. Knowledge of obesity and its impact on reproductive health outcomes among urban women. J Community Health 2013; 38:261-7. [PMID: 22961295 DOI: 10.1007/s10900-012-9609-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This prospective survey study assessed the knowledge of reproductive outcomes that are affected by obesity among women in an urban community. A total of 207 women attending a community fair on the south side of Chicago participated in the study. A survey assessing knowledge of BMI and of the effects of obesity on general, cardiometabolic and reproductive health outcomes was administered. Subjects ranged in age from 18 to 70 years (mean ± SD, 48.6 ± 12.9 years) and ranged in BMI from 17.3 to 52.1 kg/m(2) (mean ± SD, 31.2 ± 6.7 kg/m(2)). The following percentages of women were aware that obesity increases the risk of miscarriage (37.5 %), irregular periods (35.8 %), infertility (33.9 %), cesarean section (30.8 %), breast cancer (28.0 %), birth defects (23.7 %), stillbirth (14.1 %), and endometrial cancer (18.1 %). This study found that while women in an urban community are aware of the cardiometabolic risks associated with obesity, they demonstrate limited knowledge of the effects of obesity on reproductive outcomes. Public education is needed to increase knowledge and awareness of the reproductive consequences of obesity. Women of reproductive age may be uniquely responsive to obesity education and weight loss intervention.
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Affiliation(s)
- Eden R Cardozo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Shub A, Huning EYS, Campbell KJ, McCarthy EA. Pregnant women's knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes 2013; 6:278. [PMID: 23866845 PMCID: PMC3726511 DOI: 10.1186/1756-0500-6-278] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/01/2013] [Indexed: 11/13/2022] Open
Abstract
Background Obesity is increasingly common in the obstetric population. Maternal obesity and excess gestational weight gain (GWG) are associated with increased perinatal risk. There is limited published data demonstrating the level of pregnant women’s knowledge regarding these problems, their consequences and management strategies. We aimed to assess the level of knowledge of pregnant women regarding: (i) their own weight and body mass index (BMI) category, (ii) awareness of guidelines for GWG, (iii) concordance of women’s own expectations with guidelines, (iv) knowledge of complications associated with excess GWG, and (v) knowledge of safe weight management strategies in pregnancy. Methods 364 pregnant women from a single center university hospital antenatal clinic were interviewed by an obstetric registrar. The women in this convenience sample were asked to identify their weight category, their understanding of the complications of obesity and excessive GWG in pregnancy and safe and/or effective weight management strategies in pregnancy. Results Nearly half (47.8%) of the study population were overweight or obese. 74% of obese women underestimated their BMI category. 64% of obese women and 40% of overweight women overestimated their recommended GWG. Women’s knowledge of the specific risks associated with excess GWG or maternal obesity was poor. Women also reported many incorrect beliefs about safe weight management in pregnancy. Conclusions Many pregnant women have poor knowledge about obesity, GWG, their consequences and management strategies. Bridging this knowledge gap is an important step towards improving perinatal outcomes for all pregnant women, especially those who enter pregnancy overweight or obese.
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Affiliation(s)
- Alexis Shub
- Department of Obstetrics and Gynaecology, University of Melbourne, Perinatal Centre, 3rd Floor, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria, 3078, Australia.
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Forsum E, Brantsæter AL, Olafsdottir AS, Olsen SF, Thorsdottir I. Weight loss before conception: A systematic literature review. Food Nutr Res 2013; 57:20522. [PMID: 23503117 PMCID: PMC3597776 DOI: 10.3402/fnr.v57i0.20522] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 01/07/2013] [Accepted: 01/30/2013] [Indexed: 11/14/2022] Open
Abstract
The prevalence of overweight and obesity in women has increased during the last decades. This is a serious concern since a high BMI before conception is an independent risk factor for many adverse outcomes of pregnancy. Therefore, dietary counseling, intended to stimulate weight loss in overweight and obese women prior to conception has recently been recommended. However, dieting with the purpose to lose weight may involve health risks for mother and offspring. We conducted a systematic literature review to identify papers investigating the effects of weight loss due to dietary interventions before conception. The objective of this study is to assess the effect of weight loss prior to conception in overweight or obese women on a number of health-related outcomes in mother and offspring using studies published between January 2000 and December 2011. Our first literature search produced 486 citations and, based on predefined eligibility criteria, 58 were selected and ordered in full text. Two group members read each paper. Fifteen studies were selected for quality assessment and two of them were considered appropriate for inclusion in evidence tables. A complementary search identified 168 citations with four papers being ordered in full text. The two selected studies provided data for overweight and obese women. One showed a positive effect of weight loss before pregnancy on the risk of gestational diabetes and one demonstrated a reduced risk for large-for-gestational-age infants in women with a BMI above 25 who lost weight before pregnancy. No study investigated the effect of weight loss due to a dietary intervention before conception. There is a lack of studies on overweight and obese women investigating the effect of dietary-induced weight loss prior to conception on health-related variables in mother and offspring. Such studies are probably lacking since they are difficult to conduct. Therefore, alternative strategies to control the body weight of girls and women of reproductive age are needed.
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Affiliation(s)
- Elisabet Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Hammarberg K, Setter T, Norman RJ, Holden CA, Michelmore J, Johnson L. Knowledge about factors that influence fertility among Australians of reproductive age: a population-based survey. Fertil Steril 2012; 99:502-7. [PMID: 23158832 DOI: 10.1016/j.fertnstert.2012.10.031] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/02/2012] [Accepted: 10/16/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age. DESIGN Telephone survey of a representative sample of Australians. SETTING Not applicable. PATIENT(S) Australians aged 18 to 45 years who wish to have a child or another child now or in the future. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse. RESULT(S) A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive. CONCLUSION(S) Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education campaign to promote awareness of factors that influence fertility.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia.
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de Jersey SJ, Nicholson JM, Callaway LK, Daniels LA. A prospective study of pregnancy weight gain in Australian women. Aust N Z J Obstet Gynaecol 2012; 52:545-51. [PMID: 23113826 DOI: 10.1111/ajo.12013] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/18/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND While weight gain during pregnancy is regarded as important, there has not been a prospective study of measured weight gain in pregnancy in Australia. This study aimed to prospectively evaluate pregnancy-related weight gain against the Institute of Medicine (IOM) recommendations in women receiving antenatal care in a setting where ongoing weight monitoring is not part of routine clinical practice, to describe women's knowledge of weight gain recommendations and to describe the health professional advice received relating to gestational weight gain (GWG). METHODS Pregnant women were recruited ≤20 weeks of gestation (n = 664) from a tertiary obstetric hospital between August 2010 to July 2011 for this prospective observational study. Outcome measures were weight gain from pre-pregnancy to 36 weeks of gestation, weight gain knowledge and health professional advice received. RESULTS Thirty-six percent of women gained weight according to guidelines. Twenty-six percent gained inadequate weight, and 38% gained excess weight. Fifty-six percent of overweight women gained weight in excess of the IOM guidelines compared with 30% of those who started with a healthy weight (P < 0.001). At 16 weeks, 47% of participants were unsure of the weight gain recommendations for them. Sixty-two percent of women reported that the health professionals caring for them during this pregnancy 'never' or 'rarely' offered advice about how much weight to gain. CONCLUSIONS The prevalence of inappropriate gestational weight gain in this study was high. The majority of women do not know their recommended weight gain. The advice women received from health professionals relating to healthy weight gain in pregnancy could be improved.
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Affiliation(s)
- Susan J de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Hinkle SN, Schieve LA, Stein AD, Swan DW, Ramakrishnan U, Sharma AJ. Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age. Int J Obes (Lond) 2012; 36:1312-9. [PMID: 22964791 PMCID: PMC4583192 DOI: 10.1038/ijo.2012.143] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Both underweight and obese mothers have an increased risk for adverse offspring outcomes. Few studies have examined the association between prepregnancy body mass index (BMI) and children's neurodevelopment. SUBJECTS We used data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n=6850). Children were classified according to their mother's prepregnancy BMI (kg m(-2)) status: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class I (BMI 30.0-34.9), and obese class II and III (BMI ≥35.0). Children's age-adjusted mental development index (MDI) and psychomotor development index (PDI) T-scores (mean 50, s.d. 10) were obtained using a validated shortened version of the Bayley Scales of Infant Development-II at approximately 2 years of age. While adjusting for sociodemographics, we estimated the average MDI and PDI scores or the risk of delayed (<-1 s.d. vs >1 s.d.) mental or motor development, relative to children of normal weight mothers. RESULTS Compared with children of normal weight mothers, MDI scores were lower among children of mothers of all other prepregnancy BMI categories, with the greatest adjusted difference among children of class II and III obese mothers (-2.13 (95% CI -3.32, -0.93)). The adjusted risk of delayed mental development was increased among children of underweight (risk ratio (RR) 1.36 (95% CI 1.04, 1.78)) and class II and III obese (RR 1.38 (95% CI 1.03, 1.84)) mothers. Children's PDI scores or motor delay did not differ by maternal prepregnancy BMI. CONCLUSION In this nationally representative sample of 2-year-old US children, low and very-high maternal prepregnancy BMI were associated with increased risk of delayed mental development but not motor development.
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Affiliation(s)
- S N Hinkle
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
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Willcox JC, Campbell KJ, van der Pligt P, Hoban E, Pidd D, Wilkinson S. Excess gestational weight gain: an exploration of midwives' views and practice. BMC Pregnancy Childbirth 2012; 12:102. [PMID: 23013446 PMCID: PMC3531303 DOI: 10.1186/1471-2393-12-102] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers' views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives' views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions. METHODS Midwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Midwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG. CONCLUSIONS The findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives' engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG.
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Affiliation(s)
- Jane C Willcox
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | | | - Shelley Wilkinson
- Mater Mothers’ Hospital, Brisbane, Australia
- Mater Medical Research Institute, Brisbane, Australia
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Stewart ZA, Wallace E, Allan C. Weight gain in pregnancy: a survey of current practices in a teaching hospital. Aust N Z J Obstet Gynaecol 2012; 52:208-10. [DOI: 10.1111/j.1479-828x.2012.01418.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 01/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Zoe A. Stewart
- Department of Obstetrics and Gynaecology; Monash University
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Thompson MW, Nassar N, Robertson M, Shand AW. Pregnant women's knowledge of obesity and ideal weight gain in pregnancy, and health behaviours of pregnant women and their partners. Aust N Z J Obstet Gynaecol 2012; 51:460-3. [PMID: 21988119 DOI: 10.1111/j.1479-828x.2011.01328.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a survey among a convenience sample of 149 women and their partners (n = 136) attending antenatal services in the Canberra Hospital in 2010. Over one-third (39%) of women and 63.6% of their partners were overweight/obese, and 69.2% of women had not received advice from their caregiver on their weight. Pregnant women and their partners' health behaviours including smoking, and fruit and vegetable intake were strongly correlated (P ≤ 0.01). Pregnant women require targeted advice on their weight, ideal weight gain and impact of these on pregnancy.
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Affiliation(s)
- Matthew W Thompson
- The Australian National University, Canberra, Australian Capital Territory, Australia
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Nitert MD, Foxcroft KF, Lust K, Fagermo N, Lawlor DA, O'Callaghan M, McIntyre HD, Callaway LK. Overweight and obesity knowledge prior to pregnancy: a survey study. BMC Pregnancy Childbirth 2011; 11:96. [PMID: 22103736 PMCID: PMC3240826 DOI: 10.1186/1471-2393-11-96] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/21/2011] [Indexed: 11/24/2022] Open
Abstract
Background Overweight and obesity are associated with increased risk for pregnancy complications. Knowledge about increased risks in overweight and obese women could contribute to successful prevention strategies and the aim of this study is to assess current levels of knowledge in a pregnant population. Methods Cross sectional survey of 412 consecutive unselected women in early pregnancy in Brisbane, Australia: 255 public women attending their first antenatal clinic visit and 157 women at private maternal fetal medicine clinics undergoing a routine ultrasound evaluation prior to 20 weeks gestation. The cohort was stratified according to pre pregnancy BMI (< 25.0 or ≥ 25.0). The main outcome measure was knowledge regarding the risks of overweight and obesity in pregnancy. Results Over 75% of respondents identified that obese women have an increased risk of overall complications, including gestational diabetes and hypertensive disorders of pregnancy compared to women of normal weight. More than 60% of women asserted that obesity would increase the risk of caesarean section and less than half identified an increased risk of adverse neonatal outcomes. Women were less likely to know about neonatal complications (19.7% did not know about the effect of obesity on these) than maternal complications (7.4%). Knowledge was similar amongst women recruited at the public hospital and those recruited whilst attending for an ultrasound scan at a private clinic. For most areas they were also similar between women of lower and higher BMI, but women with BMI < 25.0 were less likely to know that obesity was associated with increased rate of Caesarean section than those with higher BMI (16.8% versus 4.5%, P < 0.001). Higher educational status was associated with more knowledge of the risks of overweight and obesity in pregnancy. Conclusions Many women correctly identify that overweight and obesity increases the overall risk of complications of pregnancy and childbirth. The increased risks of maternal complications associated with being obese are better known than the increased risk of neonatal complications. Maternal education status is a main determinant of the extent of knowledge and this should be considered when designing education campaigns.
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Affiliation(s)
- Marloes Dekker Nitert
- School of Medicine, Royal Brisbane Clinical School, The University of Queensland, Brisbane, Australia
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